Demand for plastic surgery growing among Canada’s youth

Nicole Goldstein was just 17, finished high school and about to start community college, when she took the step she had been dreaming of through years of cruel taunting, and finally had her plus-sized nose surgically transformed.

Her older sister underwent a nose job at the same time, and Ms. Goldstein said she knows many other teenage girls who have had similar operations recently while in high school or college. At clinics across the country, meanwhile, cosmetic surgeons are performing operations to fix protruding ears on even younger children — some barely out of Kindergarten — in what has become a surprising and contentious phenomenon.

Doctors say they see a sharp spike at this time of year in the number of young aestheic-surgery patients like Ms. Goldstein, eager to have their operation and heal in time for the return to class, be it in Grade 1 or first-year university.

One British Columbia cosmetic surgeon even recommends children get such work done as early in life as possible to extract full benefit from their new, improved look. In Ontario, the ear surgery is covered by the province’s medicare system for patients under 18 years old.

“The idea behind doing it at an early age … is we want them to enjoy the advantages,” said Dr. Tom Buonassisi, a Vancouver facial plastic-surgery specialist. “If they have a very, very prominent feature … it helps them emotionally at an early age.”

Others, however, call the trend a particularly disturbing symbol of an image-obsessed era, telegraphing to children that people should conform to narrow definitions of beauty, rather than embrace imperfection.

Nevertheless, Dr. Buonassisi said he sees a spike of about 30% in the number of child and teenage patients at his 8 West Cosmetic Surgery clinic this time of year. Dr. Philip Solomon, a Toronto facial cosmetic and reconstructive surgeon, said he experiences a similar seasonal bump, noting that he had done nose jobs on five teenagers heading off to university one day earlier this week.

Over the course of the year he said he operates on more than 100 teenagers and 50 younger children, part of an “exploding” cosmetic surgery market that has seen patients come to him from an increasingly broad range of demographic backgrounds.

About 60-70% of the cosmetic ear operations Dr. Buonassisi does are on children under 10, he said.

Ms. Goldstein, now 19, said her large nose seemed out of proportion with her petite body, and “all through childhood” had asked her parents about getting the hated proboscis made smaller.

“Kids are really mean, and a lot of people did comment on it,” said the recent graduate of the fashion program at Toronto’s George Brown College. “I’m so much happier, I have so much more self-confidence. I think it was the best thing I could have done.”

Rhinoplasty, or nose reshaping, can be performed once the nose has stopped growing — about age 14 to 16 for girls, 17 or 18 for boys, physicians say. Otoplasty, the ear operation, is done as early as age five, by which time the appendage is fully formed. In fact, some parents come in to talk to Dr. Buonassisi about operating on children when they are just three or four years old, though they’re told to come back in a couple of years.
Young children are put under general anesthetic for both procedures.

Sometimes, teenage girls show up on their own, asking for the procedures without their parents’ knowledge, which presents a dilemma to surgeons, said Dr. Solomon.

With elementary-school-age youngsters, the motive is typically a self-consciousness about ears that stick out too far and become an unwanted focus of attention, said Dr. Buonassisi. As often as not with those children, it is the parents more than the patients who are anxious to get the work done, having had unpleasant experiences themselves with the same inherited trait.

In Ontario, the provincial government picks up the $500 fee for the ear reshaping operation on children under 18, the only purely cosmetic procedure covered by medicare, said Dr. Solomon. Work on “outstanding ears” is listed under operations for “congenital deformities” in the province’s medical fee schedule.

If previous generations felt slightly sheepish about admitting to undergoing cosmetic work, adolescents today seem more open about their operations, even sometimes posting before-and-after photographs on their Facebook page, said Dr. Solomon. That, in turn, has inspired others to consider surgery.

Teenage girls are also influenced by news of celebrities getting work done, he said, such as the 20-something pop star who reportedly had a nose job in 2006.

“When that became widespread information to the public in media like People magazine, I had an upswing in patients coming in and saying ‘I want a nose like Ashlee Simpson.’ ” recalled Dr. Solomon. “They’ll come in with a picture of [reality TV star Kim] Kardashian, liking her lips, liking her cheeks. I also find a lot of young girls are getting lip enhancements. If they get their nose done and they have small lips, they want an injection of things like Restylane.”

To some observers, however, cosmetic surgery for children and teenagers is simply wrong.

Quite apart from the sociological considerations, any operation under anesthetic carries risks, which normally are weighed against the medical benefits of a procedure, not the aesthetic results, said Anne Rochon Ford, executive director of the Canadian Women’s Health Network.

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But the phenomenon is also typical of a society that has put increasing pressure on girls, especially, to fit themselves into a narrow ideal of physical appearance, and has “normalized” cosmetic medicine, she said.

“People are prepared to put their children through surgery to supposedly look better? That I find is a very disturbing commentary on our culture,” said Ms. Rochon Ford. “What that does is only increase prejudice and ill viewing of anybody that veers from that norm, which is completely insane.”

The surgeons say they are cognizant of such criticism, and will typically refuse to perform the procedures on children whose features seem in little need of enhancement, or whose parents appear to be pushing surgery for dubious reasons.

“In a perfect world, we wouldn’t care about those [body image] things,” conceded Dr. Buonassisi while at the same time stressing the emotional benefits of nose and ear work. Even his receptionist, he said, notices how much more confident children seem when they come back for their check-up after six weeks.

Ms. Goldstein said revamping the nose that had been the brunt of so much teasing made a world of difference to her, but also suggests that today’s beauty-obsessed culture is driving young people to the operating room.

“If the media is going to put out publications and videos and whatnot of these beautiful people … how can our society expect us to be OK with who we are?” she asks. “Everyone wants to be that little bit closer to something they see in the media, something they see as perfect.”